A Bard’s Tale
Like most of you, I have fond memories of childhood. My family moved from the metropolis of Acton to the pretty and quaint village of Oakville in 1979. It was a good childhood filled with street hockey played in the parking lot of our local church, bike rides to the arcade at Trafalgar Village or the Comic Connection on Kerr Street.
Another fond memory is that of Dungeons and Dragons, otherwise known as D&D. I can’t remember who got me into it or when I started playing, but I do remember the red Basic rules box with the two books contained therein. This would be followed by the blue Expert edition, green Companions rules and then the black Masters rules. This would be soon followed by Advanced D&D, in the form of hard cover books such as the Players Handbook, Dungeon Master’s Guide, Monster Manual (1&2) with a more intense set of rules for play. The artwork on each was stunning and stands the test of time. I remember going to Pick of the Crop in downtown Oakville to look for the newest modules or miniature figurines.
The history of D&D is fascinating and well chronicled in the book “Of Dice and Men” for those of you are sweating nostalgia right now or even those who simply want a better understanding of this cultural phenomenon. In recent years, there has been a resurgence in interest in D&D, with well known celebrities playing and promoting the game including Deborah Ann Woll, Vin Diesel and Dame Judi Dench, just to name a few. A blockbuster movie starring Chris Pine “Dungeons and Dragons: Honor Among Thieves” drops March 31 (writing that without the “u’s” really bothered me).
While many claim to have loved and read Tolkien’s Lord of the Rings growing up (I don’t believe half of them), I was more privy to the Dragonlance series by Margaret Weis and Tracy Hickman. It is based on a D&D campaign that follows a band of characters as they criss-cross Krynn battling the forces of evil to prevent the return of Takhisis, an evil goddess who often appears in the form of a six headed dragon.
I credit D&D with my love of reading, logical way of thinking (usually anyways) and certainly a vivid imagination. And remarkably, I did not worship Satan or join a cult (yes, that was a “concern” back in the 1980s.)
I recently saw this tweet on Twitter.
I thought about it and after a minute or two, then I replied:
Bard.
There are many character classes in D&D. The most common are fighters, magic-users, clerics and paladins. Some players enjoy being thieves or druids. But one of the most underrated is the Bard.
A Bard is described as “In the worlds of D&D, words and music are not just vibrations of air, but vocalizations with power all their own. The bard is a master of song, speech, and the magic they contain. Bards say that the multiverse was spoken into existence, that the words of the gods gave it shape, and that echoes of these primordial Words of Creation still resound throughout the cosmos. The music of bards is an attempt to snatch and harness those echoes, subtly woven into their spells and powers.”
I never played a Bard back in the day. I viewed them as wimpy and less than helpful when battling kobolds, orcs and the occasional troglodyte. What good was a stringed instrument against Lolth, Queen of spiders and her Drow, or a witty story against Orcus, demon lord of the Undead? How can one talk their way out of certain death against the Darklord of Ravenloft, Strahd von Zarovich or sing to survive the terrors of Castle Amber?
Unbeknownst to a younger self, the power of the Bard lay not in their strength or weapons, but in their stories and ability to influence others. Indeed, the best Bards have a high Charisma and Dexterity.
So what does this have to do with palliative care in Canada?
I knew precious little about Narrative Medicine when I graduated from that medical school in London (the one without a division or department of Palliative Medicine). But Narrative Medicine is described as:
“a discipline of applying the skill of analyzing literature to interviewing patients.[1] A basic premise of Narrative Medicine is that how a patient speaks about their illness or problem is similar to a story in literature in that the account has a "plot" (how they relate what is going on) with "characters" (themselves and others in their lives) and is filled with "metaphors" (picturesque, emotional and symbolic ways of speaking), and becoming conversant in literary stories facilitates understanding the stories which patients bring. Narrative Medicine is a medical approach that utilizes patients' narratives in clinical practice, research, and education as a way to promote healing. Beyond the attempt to reach a more accurate diagnosis, it aims to address the relational and psychological dimensions that occur in tandem with physical illness, with an attempt to deal with the individual stories of patients. In doing this, narrative medicine aims not only to validate the experience of the patient, but also to encourage creativity and self-reflection in the physician.”
Plot? Characters? Metaphors? Literary stories? Creativity?
Sounds a lot like D&D to me.
I first wrote about a patient named Ken Owen. Ken was a social worker, a member of what I have always referred to as the “Trinity” in palliative care (doctors, nurses, social workers).
This was followed by Francis Ryall, who gave us his story in the name of education prior to a LEAP Core session I taught in 2015. Francis and his wife Amanda were nurses, and thus members of the aforementioned “Trinity.”
There is the story of Thorald Findley or “DJ Thor,” a DJ in Windsor whose story was elegantly brought to life by Nancy Dale, then of the OMA and Dot Dot Dash productions.
While I cannot claim credit, I can appreciate the stories of Mason Macri and Hunter Allard in my local newspaper, the Windsor Star, shining a spotlight on the need for pediatric palliative care. Mason’s love of superheroes eclipsed my own and Hunter’s John Deere bed is an image I will never forget.
There are 14 million people in Ontario who will, one day, all benefit from a palliative approach to care.
These are but a few of their stories.
Perhaps the most powerful story I’ve told was a tale of two patients, Kyra Roberts and John Dale.
Stories are powerful. They have the ability to move mountains and part the seas in ways that numbers and statistics simply cannot alone. A well told story, backed up by the appropriate metrics, statistics and evaluations, can form policy and reshape our health care system from the one we have to the one we want.
Kyra, as well as her mom Brenda, shared their story with Health Quality Ontario (HQO) for one of its yearly reports and John Dale’s story was featured in a report by the Ontario Hospital Association (OHA).
I wrote extensively about Dan Duma, a man who just wanted to come home from Alberta and be with his family in Windsor at the end of his life. He faced many obstacles and gaps in our health care system. His story paved the way for a regulation change that will prevent patients from falling into the same gaps he did. His story also showed us how health care can be improved in the spirit of non-partisan cooperation. One of my favorite pictures is Health Minister Christine Elliott speaking to Windsor West MPP Lisa Gretzky at Queen’s Park. Ottawa MPP John Fraser, although not pictured here, also deserves credit for his work behind the scenes.
These are only the stories I have put to paper. Many are still swirling. Like my patient who visited over 100 countries during his lifetime, or the sardonic patient I dedicate my more sarcastic articles to.
One day, I will share a story from a colleague and mentor, Sandy Buchman. It will outline the challenges both he and his father faced with accessing care for his father Murray.
A New York times article from 2021 highlights the importance of listening to patient stories. An article in the July 2022 issue of The New Yorker goes so far as to say that storytelling is part of being a good doctor. And we all want to be good doctors, right?
And narrative medicine is not just confined to physicians. Narrative [medicine] can help nurses and social workers better relate to patients and their struggles.
The Ancient Egyptians believed we all die twice. First, when we take our last breath. Second, when our name is spoken for the last time.
By my rough (like an ogre’s tongue) estimate, I have cared for a few thousand patients in my community over my 17-year career and twice that number in our hospice residences in Windsor and Leamington.
I have sat on a thousand couches, in a thousand homes and listened to a thousand stories.
Like Chris Pine’s Bard in “Honor Among Thieves,” I wander the countryside (suburbs) of the land looking for stories to tell.
A life well lived is a life worth remembering, no matter how long or short they might be.
“Something is not beautiful because it lasts.” -Vision (2012 Avengers: Age of Ultron)
(yeah, I had to get one Marvel reference in)
So let’s hear it for the Bard. A wistful wanderer, mythical minstrel and travelling troubadour.
If we are truly interested in meaningful health system transformation and quality improvement, we need to tell more patient stories.
So get writing, and share those stories.
(And can someone please explain Saving Throws to me in the 5th edition?!)